Child Enrolment Details

CHILD ENROLMENT DETAILS

ENROLMENT FORM Date: ______

A parent or guardian who has Lawful Authority to the child must complete this form. A brief explanationof Lawful Authority is included in this form. Questions marked with an asterisk * are not required by the Education and Care Services National Lawand the Education and Care Services National Regulationsbut you are encouraged to answer these to assist inproviding relevantchildren services. The Centre respects your right to information privacy. Information we collect and hold on your personal details is kept in accordance with information privacy laws.

A. INFORMATION ABOUT THE CHILD

Child’sfirst name: ______Surname: ______

Date ofbirth: ______* Gender: male ☐ female ☐ (please tick)

Home address: ______

Language(s) spoken at home: ______

* Is the child of Aboriginal and/or Torres Strait Islander descent? Yes ☐ No ☐

* Does the child have any additional developmental needs? Yes ☐ No ☐

B. INFORMATION ABOUT THE CHILD’S PARENT/S OR GUARDIAN/S

Enrolmentform for (child's name): ______

CHILD ENROLMENT DETAILS

NAME: ______

(Relationship to the child):______

Address: as per child ☐ or

______

Phone:(Home) ______

(Work) ______

(Mobile) ______

Email:______

Does the child live with this person?

Yes ☐ No ☐

NAME: ______

(Relationship to the child): ______

Address: as per child ☐ or

______

Phone:(Home) ______

(Work) ______

(Mobile) ______

Email:______

Does the child live with this person?

Yes ☐ No ☐

Enrolmentform for (child's name): ______

CHILD ENROLMENT DETAILS

Are there any other parent/s or guardian/s? Yes ☐ No ☐ If yes, please give details:

Name: ______Relationship: ______

Address: ______Phone: ______

______

C. OTHER PERSONS TO BE NOTIFIED

There may be times when the child has an accident, injury, trauma or illness and the parents or guardianscannot be contacted. In this instance, the children’s service will notify one of the followingpeople who are authorised to collect and care for the child after accident, injury, trauma or illness.

Name / Address / Relationship to child / Telephone
1. / Home:
Work:
Mobile:
2. / Home:
Work:
Mobile:

D. COLLECTING THE CHILD FROM THE CENTRE

Your consent is required for other people to collect your child from the children’s service on your behalf.Please list details of those people who can collect your child in the table below (this list may be added to orchanged throughout the year).

In the event that your child is not collected from the children’s service and the parents or guardians cannot becontacted, the contacts on this list will also be contacted to arrange for someone to collect your child.

Name / Address / Relationship to child / Telephone
1. / Home:
Work:
Mobile:
2. / Home:
Work:
Mobile:
3. / Home:
Work:
Mobile:
4. / Home:
Work:
Mobile:
5. / Home:
Work:
Mobile:

E. COURT ORDERS RELATING TO THE CHILD

Are there any court orders relating to the powers and responsibilities of the parent/s in relation to the child oraccess to the child?

Yes ☐ If yes, please complete the following

No ☐If no, go to section F

1. Provide the original court order for Centre staff to see and to copy to attach to this enrolment form.

2. If these orders:

a) change the powers of parent/guardian to:

• authorise the taking of the child outside the service by a staff member of theservice

• consent to the medical treatment of the child

• request or permit the administration of medication to the child

• collect the child AND/OR

b) give these powers to someone else;please describe these changes and provide the contact details of any person given these powers:

Lawful authority

Parents - All parents have powers and responsibilities in relation to their children that can only bechanged by a court order. The Children’s Services Regulations 2009 refer to these powers andresponsibilities as ‘Lawful Authority’. It is not affected by the relationship between the parents, such aswhether or not they have lived together or are married. A court order, such as under the Family Law Act,may take away the authority of a parent to do something, or may give it to another person.

Guardians - A guardian of a child also has a Lawful Authority. A legal guardian is given Lawful Authorityby a court order. The definition of ‘guardian’ under the Children’s Services Regulations 2009 also coverssituations where a child does not live with his or her parents and there are no court orders. In thesecases, the guardian is the person the child lives with who has day-to-day care and control of the child.

F. CHILD’S MEDICAL & HEALTH INFORMATION

Has the child been immunised? Yes ☐ No ☐ (please tick)

Have immunisation records been sighted by Centre staff? Yes ☐ No ☐ Staff initials:______

Is a copy of the immunisation records attached? Yes ☐ No ☐ Date: ______

Name of doctor/ Medical service:______Phone:______
Address of doctor/ Medical service______
* Maternal & Child Health Centre: (if known)______
Child health records sighted by Centre staff? Yes ☐ No ☐
Are you a member of an ambulance fund? Yes ☐ No ☐
If Yes, membership number: ______(We highly recommend you acquire a membership as the Centre will not be liable for any costs associated with the transportation of your child in an ambulance, if necessary).
Has your child been diagnosed as at risk of anaphylaxis? Yes ☐ No ☐
If yes, a copy of the current Anaphylaxis Medical Management Plan must be completed and attached. This form can be obtained from the office.
Does the child have any allergies or sensitivities? (e.g. asthma)? Yes ☐ No ☐
If yes, please give details:
The following management procedures are to be followed:
If asthma, a copy of an Asthma Action Plan is completed and attached. This form can be obtained from the office.
Does your child have any medical conditions or specific additional needs? (e.g. epilepsy, diabetes, grommetsetc)?
Yes ☐ No ☐ If yes, please give details:
The following management procedures are to be followed:
Does your child have any dietary restrictions?
Yes ☐ No ☐ If yes, the following restrictions apply:

G. DECLARATION & CONSENT

I, ______(print full name)
A person with lawful authority of the child ______referred to in this enrolment form:
• Consent to the staff of the children’s service seeking, or where appropriate, administering, suchemergency medical treatment as is reasonably necessary and that I will reimburse any necessary expenses incurred by the children’s service.
• Declare that the information in this enrolment form is true and correct and undertake to immediately inform the children’s service in the event of any change to this information.
• Agree to collect or make arrangements for the collection of the child referred to in this enrolment form if he/she becomes unwell at the service.
• Agree to reimburse the Centrefor any expenses incurred (e.g.costs associated with late collection of child).
Signature ______Date ______

H. GETTING TO KNOW YOUR CHILD

To assist our staff in getting to know your child andin planning the sessions they will be attending, please fill in the following information sheet.

Enrolmentform for (child's name): ______

CHILD ENROLMENT DETAILS

Child's name ______

Date of birth ______

Toilet trained Yes □ No □

Has your child been left before? Yes □ No □

Mother’s/Guardian’s name ______

Father’s/Guardian’s name______

Does your child have any brothers or sisters?

______

(first name) (age) (gender)

______

(first name) (age) (gender)

______

(first name) (age) (gender)

______

(first name) (age) (gender)

Does your child have any pets? If so please list them.

______

(type of animal) (name)

______

(type of animal) (name)

Fears or dislikes?(please circle)

Loud noises, dogs, balloons, loud music

Other: ______

Special occasions your family celebrates:

Which activities does your child enjoy?

(eg. Pasting, singing, dancing, outside play)

Other:______

Are you aware of anything in which your child has a particularinterest? (please circle)

Trucks, trains, planes, building with blocks

drawing, dancing, singing, music

Other: ______

What are some of your child’s favourite foods?

______

What are some of your child’s least favourite foods? ______

______

Any other information you would like to share with us: ______

Enrolmentform for (child's name): ______

CHILD ENROLMENT DETAILS

I. CONSENT TO PHOTOGRAPH

During your child’s attendance there may be occasions when they are photographed.

Reasons for this may include: Observations of your child engaged in play, displays, Centre promotions and/or other activities and professional photographs that will be made available forparents to purchase. Please sign below if you wish to provides your consent.

Child’s name: ______

Parent or Legal Guardian's signature: ______

Date: ______

Enrolmentform for (child's name): ______